Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019

Abstract

Background Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam. Methods We analyzed data of 7,541 adolescents aged 13–17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models. Findings The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 – 0·93; females: OR = 0·69, 95% HDI: 0·47 – 0·98). Interpretation Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence. Funding The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.

Assuring Bangladesh’s future: non-communicable disease risk factors among the adolescents and the existing policy responses

“…In our study, we found that insufficient fruits, insufficient vegetables and fats food consumption are the three common risk factors among the adolescent. This is similar to an analysis in Vietnam that reported low fruit/vegetable intake and unhealthy diet were common among school-going adolescents aged 13–17 years [ 7 , 9 ]. Similar to some other Asian countries, we found that smoking and alcohol prevalence is comparatively low in Bangladesh [ 8 , 10 ].…”

“…Similar to some other Asian countries, we found that smoking and alcohol prevalence is comparatively low in Bangladesh [ 8 , 10 ]. Although in our study we did not explore any school health promotion programs for improving adolescent health wellbeing, a recent study in Vietnam reported high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors [ 7 , 9 ].…”

“…These include, but not limited to tobacco and alcohol use, poor diet, and insufficient physical activity [ 6 ]. According to the Lancet Commission on Adolescent Health (2016), tobacco use, alcohol consumption, overweight, obesity, and mental health problems were identified as the major health risks for adolescents around the world [ 7 , 9 ]. Early tobacco use is a major risk factor for NCDs throughout the life.…”

“…Bangladesh is categorized as a ‘multi-burden country’—i.e., high rate of Communicable/maternal/nutritional, high rate of injury, and a high rate of NCDs for adolescents [ 7 , 9 ]. The government of Bangladesh has duly recognized this complex profile of need and has formulated a number of policy documents and strategies to address the NCD burden and associated risk factors.…”

Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: A population-based study

“… 1 , 2 Risk factors such as poor diet, smoking, sedentary behaviour, and overweight/obesity increase the risk of NCDs, with most of these commencing in early life, impacting health throughout the life course. 3 Among adolescents aged 10–20 years, physical inactivity and sedentary behaviour (e.g., watching television, gaming, and computer and smartphone use) have been linked with increased obesity and adiposity, poor diet (insufficient fruits and vegetable consumption, salt, sugar-sweetened beverages and saturated fat consumption, low iron etc), depression, and reduced quality of life. 4 , 5 Globally, unhealthy diet mainly from the consumption of sugar-sweetened beverages and saturated fat increases the risk of CVD.…”